KOK Edit: Your favorite copyeditor since 1984(SM)
KOK Edit: your favorite copyeditor since 1984(SM) KOK Edit: your favorite copyeditor since 1984(SM) Katharine O'Moore Klopf

Tuesday, June 13, 2006

"Breast-Feed or Else"

Says an article [or here] in today's New York Times:

Warning: Public health officials have determined that not breast-feeding may be hazardous to your baby's health.

There is no black-box label like that affixed to cans of infant formula or tucked into the corner of magazine advertisements, at least not yet. But that is the unambiguous message of a controversial government public health campaign encouraging new mothers to breast-feed for six months to protect their babies from colds, flu, ear infections, diarrhea and even obesity. In April, the World Health Organization, setting new international bench marks for children's growth, for the first time referred to breast-feeding as the biological norm.

I so wish there was such a label!

Senator Tom Harkin, Democrat of Iowa, has proposed requiring warning labels, on cans of infant formula and in advertisements, similar to the those on cigarettes. They would say that the Department of Health and Human services has determined that "breast-feeding is the ideal method of feeding and nurturing infants" or that "breast milk is more beneficial to infants than infant formula."

But that may not happen for quite a long time because, as the Times article says, "critics say the new campaign has taken things too far and will make mothers who cannot breast-feed, or choose not to, feel guilty and inadequate."

Of course there are some mothers who can't breast-feed, and they shouldn't feel inadequate because of that. But why worry about the feelings of those who can breast-feed but choose not to? Do medical researchers worry about the feelings of people who continue to smoke in the face of evidence that their behavior can kill them and make others around them ill?

It's time for mainstream medicine to stop tiptoeing around mothers and say that if babies are to be healthiest—over their entire life span—they shouldn't get formula, unless it's a medical necessity. I'd go even further and say that formula should be available only by prescription. And more physicians should be recommending that moms follow the guidelines of the American Academy of Pediatrics (AAP), which say that children should be breast-fed for a minimum of 1 year. But the AAP really should be recommending that children be breast-fed until they wean themselves. After all, the average age of children worldwide who wean themselves is 4 years. Nature programs children with healthy needs for a reason, and they should be allowed to have those needs met.

Of course, it's also time to make it illegal for formula manufacturers to provide and hospitals to hand out formula samples to new mothers. It's time, too, for employers to be required to at least set aside one room as a private place for their female employees to pump breast milk to be saved, in a clean refrigerator in that room, for their babies. And it's way past time for Americans to get over their squeamishness at seeing women breast-feed in public. If a woman's breast-feeding, she's feeding her child, not waving her boobs at people as sexual enticements.

And if she's breast-feeding, she's saving health insurance policy holders lots of bucks over her child's lifetime, by providing the food her child was meant to have.

Updated 6/16/06: Watch an antiformula, pro–breast-feeding public service ad done by the Ad Council. (You'll need a broadband or cable connection.)


erinberry said...

I definitely agree that breastmilk is best. However, I think that making formula only available by prescription could result in disproportionate hardship on poor women. Women in the middle and upper socioeconomic classes often take going to the doctor for granted... They can make an appt and afford to pay (a co-pay or full price) if they notice they are not producing enough milk (and also tend to be educated enough to know what that amount should be).

A large number of poor, unemployed, and working class people (and a growing number of middle class people) do not have insurance (as you know). They may also not have had access to as much information about how much food is necessary for an infant. If they do notice that their milk amount is not sufficient, it may be harder for them to get to a doctor's office and pay for the visit.

I do think wish that more women in the lower socioeconomic strata knew more about breastfeeding - both the monetary and health benefits of it. For the average person, breastfeeding provides tremendous cost savings!

Unfortunately that's not an option for me - I take medications that can't be used while breastfeeding, so even if I wanted to do adoptive breastfeeding I couldn't. And buying breastmilk is outrageously expensive... Not in our budget given $30,000 in adoption expenses plus ~ $15,000 we have to save so I can stay home several months after our baby comes home.

Katharine O'Moore-Klopf said...

I hear you, Erinberry, about the cost of formula. That's another reason why physicians and hospitals must emphasize breast-feeding: Breast milk costs nothing and it's portable. It's insane that poor women should be paying for formula when they have the perfect built-in infant food.

And yes, there are legitimate reasons why women can't breast-feed, such as medications they must take. But the number of women who have physical reasons why they can't breast-feed is astronomically small. Often, those who think their bodies can't make milk have been conditioned to think so by tut-tutting relatives and pediatricians or are so stressed out because of the barriers to breast-feeding that American culture and employers erect that they don't make much milk. I have firsthand knowledge of this: In the 1980s, I breast-fed my daughter (oldest child) for only 3 months because the cultural attitude back then told me I should hide when I was feeding my daughter, which meant I couldn't go out in public with her or, if I did, I had to breast-feed her in restrooms. Yuck! My sons, however, I breast-fed for 3 years (middle child) and 4 years (youngest child).

I don't think that formula available by prescription only should be sold at higher prices than it is now, so that people like you who are unable to breast-feed can afford it. But poor women can't really afford it now. And something must be done to get rid of the formula money machine. For reading on that subject, see this article and the book Milk, Money, and Madness: The Culture and Politics of Breastfeeding.

Dick Margulis said...

On the subject of not being able to breastfeed because of taking medications, there is a widespread misunderstanding among physicians about this. The warnings in the PDR and in package inserts about not breastfeeding while taking a med are CYA clauses written by lawyers, because hardly any meds are actually tested on breastfeeding mothers.

However, there are actually very few meds that are contraindications for breastfeeding. Breastfeeding medicine specialists refer to the bible on that subject, Tom Hale's, Medications and Mothers' Milk.

Any mother who has been advised to stop breastfeeding even briefly because of the need to take a particular med should insist that her physician consult that reference directly or consult with a specialist who is familiar with the book. It is much more authoritative than the FDA or the PDR on the subject.

Katharine O'Moore-Klopf said...

Thanks, Dick, for covering my omission. I used Medications and Mothers' Milk all the time as a breastfeeding mother. And here's the web site of the good Dr. Hale, which carries an article on how drugs enter breast milk.

Anonymous said...

I found your blog searching for nfo on breast feeding. I'm pregnant with my first and I intend to do it, but I see from friends that it's nt easy. Also people are so cowed into doing it these days they are afraid to tell you what they actually did.

I think making it illegal for companies to give away formula in the hospital... well that's nutty. Were you being sarcastic?

You make no mention of it, but for me the biggest outrage is the lack of support at work and in this country for mternity leave/breast feeding. I love my job, I have a husband, bt for me not going back to work is not an option. I must find the underground railroad of info about breast feeding at work and it's not easy as there are so few women with kids at the office. They seem to disappear and then not come back. And now I know why.

I work for a big -- no enormous-- profitable fun company as a writer and editor. When I heard my maternity leave from HR I had to hold back the tears. I've been there a few years and assumed it'd be better in terms of time and money. Then I heard what other friends did for maternity leave -- unemployment -- and realized I was lucky.

Anywho, thanks for the direct to the article. As one of many kids healthy successful kids who were not breastfed, I find the lactation pushers a bit distasteful. But I see the evidence that it's healthier and I am committed to doing it.

However, where can I find a woman who will give me the straight dope on what it'll do to the look of my breasts? Won't change my mind, but it's on my mind and I find the absence of info odd.

cheers and I'll check back again.

Katharine O'Moore-Klopf said...

Thanks for writing, Anon. One reason a lot of American women today find breast-feeding "not easy" is because the formula manufacturers have been so successful at pushing their products that not that many women breast-feed, and so there are few role models. But there are plenty of helpful books out there about breast-feeding, including The Womanly Art of Breastfeeding. That book and La Leche League can give you "the straight dope on what it'll do to the look of [your] breasts," among other helpful info. Consider joining a local chapter of La Leche League just before your baby is born, and you'll have plenty of breast-feeding mentors.

No, I wasn't being sarcastic about making it illegal for companies to give away formula in hospitals. Using those free samples is a mother's first step down the slope to not breast-feeding. If she doesn't breast-feed from the beginning and keep on doing it, she will not have the milk supply her baby's needs and she'll be forced to rely on formula. Breast-feeding is a use-it-or-lose-it proposition. What the formula companies are doing is like giving out cigarette samples and then wondering why people get hooked on cigarettes. The formula companies know this. A good book to read that will tell you more about this is Milk, Money, and Madness: The Culture and Politics of Breastfeeding, as I mentioned in my reply to Erinberry. Nestlé is the target of a boycott in 20 nations because it gives away free formula samples in poor nations, where women who want to be like American women use the free formula and then lose their breast milk supply by the time the samples run out and can't afford to buy formula. Formula makers don't have babies' best interests at heart; profit is their only focus.

You said that I didn't mention the outrageous lack of support at work and in this country for maternity leave and breast-feeding. But I did address that issue in my reply to Erinberry. Not going back to work has never been an option for me either, and the lack of support was one of the reasons I breast-fed my daughter only 3 months. But I was in my early twenties then and not assertive. I had my first
son at age 35 and my second at age 42. I had become very assertive by the time I was 35 and created my own work situation—self-employment—to get rid of workplace impediments to breast-feeding. But if I had chosen to continue working in an office, I know that I'd have been a tireless advocate for pumping breaks during the workday and for getting my employer to designate a room as a private pumping room for lactating mothers. (Heh ... I'm a tireless advocate for lots of issues I believe in.)

What will breast-feeding do to the look of your breasts? More than likely, when you begin breast-feeding, your breasts will become larger; you'll need a bigger (nursing) bra. I've breast-fed three children over a span of about 20 years; my 4-year-old weaned himself only this year. My breasts are soft and no longer "perky." But I'm also about to turn 47. How much a woman's breasts droop depends solely on genetics (did her mother's droop?) and breast size (large versus small). By the way, don't believe the myth that wearing bras all the time will keep your breast from drooping as you age. I—and many other women—have worn bras for years, and it makes not one whit of difference.

erinberry said...

I completely agree that Nestle's practices have been unethical and despicable. And as I said, I also support efforts to educate more poor and working class women about the monetary and health benefits of breastfeeding.

However, I am against FORCING women to do anything. It's not my place, and I don't believe it's yours, or politicians', to tell a woman that she HAS to breastfeed and that she can only use formula if she has a prescription from a doctor "letting her off the hook" (and it may feel like that to some women).

As for adoptive breastfeeding, in order to even attempt it I would have to take a drug not approved by the FDA. I am not willing to take this chance with my body.

Katharine O'Moore-Klopf said...

I see making baby formula available by prescription not as a women’s rights issue (and I am a strong advocate of women’s rights) but as a health issue for babies—and as a long-term health issue for the United States. Babies who don’t get the health protection that breast milk provides grow into adults who are more likely to become obese (and obesity is already epidemic in the United States), develop diabetes (epidemic too), and develop various cancers.

Already, mainstream medicine says that though formula is available without a prescription, it “should only be used under medical supervision.”

I understand, Erinberry, that you will need to give the child you adopt formula, and so I’m not preaching to you. You are making an informed choice. I’m talking to the vast majority of women out there who can breast-feed and yet decide in favor of formula. Many of them aren’t aware of how formula makers, serving only the American dollar, changed a nation of breast-feeding women into formula buyers. From a 1999 article in Salon:

“The manufacture and sale of commercial infant formula is an unbelievably profitable enterprise. U.S. infant-formula sales reached approximately $2.59 billion in 1993, representing a 6-percent increase over 1992. Today that figure is estimated to be at $3 billion and climbing. Since 1989, when formula companies lifted their previous voluntary ban on marketing directly to consumers, the market has grown by 54 percent [italics added]. The average bottle-feeding family in the United States spends between $800 and $2000 per year [italics added] on infant formula. ...” [EditorMom: Those figures were from 1999. Imagine how high they are now.]

“Infant-formula manufacturers attempt to hide behind the empty-sounding ‘breast is best, but ...’ disclaimer that most of them include with their advertising (although even this statement appears to be slowly disappearing from infant-formula advertising). However, the simple fact is that breast-feeding itself is the most dangerous and formidable competitor formula companies have. Every time a woman chooses to breast-feed instead of bottle-feed her baby, the pharmaceutical companies lose approximately $1,000 in sales [italics added]. Because the companies that produce formula also develop and market medications and medical supplies, they must be acutely aware that the higher rates of illness suffered by formula-fed children as a group also affects their bottom line, possibly even more than the sale of the formula itself. For example, Abbott Laboratories, aside from making Similac and Isomil, also produces Pediasure, an oral rehydrating solution for infants and young children with diarrheal disease. The company also produces antibiotics widely used to treat infant infections, as well as products for diabetics.

“Experts agree that there is a role for the appropriate use of commercial infant formula. It should always be used for infants under 12 months in lieu of any type of homemade formula or whole cow, goat, or soy milk. The problem, they say, is with the way it is marketed and represented to parents.

“ ‘Infant formula should be seen for what it is: a pharmaceutical product, not for routine use,’ says Dr. Dettwyler. ‘The way these companies market it as equivalent to breast milk and just one equal choice among several is wrong.’ ”

What the formula makers—and much of American society—don't tell women either is that extended breast-feeding helps protect women against breast cancer: “A study by Yale University researchers showed that women who breastfed for two years or longer reduced their risk of breast cancer by 50 percent.”

Not shouting that information from the rooftops is, I think, a crime against women.

erinberry said...

Katharine, I definitely see your point and agree with *almost* everything you've said. For the vast majority of cases, I absolutely agree that breastfeeding is best for both mother and baby. I just think it's a slippery slope when saying it's not a women's rights issue but solely a baby's health issue... Anti-abortion activists use the same type of argument. Legislating what a woman must or must not do with her own body is tough for me to swallow.

Katharine O'Moore-Klopf said...

Erinberry, I appreciate your calm civility as you and I have been disagreeing on this issue. Thank you.

You and I will likely have to agree to disagree. I don't see making formula available by prescription only as telling women what to do with their bodies. After all, birth control pills aren't available over the counter. And that's because they should be taken only under medical supervision, just as formula should be given to infants only under medical supervision. Some babies develop allergies to some kinds of formulas, and formula is much more likely than breast milk to aggravate the temporary gastroesophageal reflux that a good many babies are born with simply because their digestive systems, like most other body systems, aren't fully mature at birth. Anyone interested in reading more about infant reflux, aka "colic," should pick up a copy of Colic Solved: The Essential Guide to Infant Reflux and the Care of Your Crying, Difficult-to-Soothe Baby, by pediatric gastroenterologist Bryan Vartabedian, available from Ballantine Books in February 2007. (I was privileged to be the freelance copyeditor for the book.)

erinberry said...

There's not a whole lot we're disagreeing about, really! I appreciate your perspective and agree with a lot of what you've said on the topic.

Dick Margulis said...


Regarding inducing lactation for an adoption, you indicated you think you have to take a non-approved drug. That is not the case. Please contact me privately by email for a referral to a physician who has helped many adoptive mothers induce lactation.


Template created by Makeworthy Media